Elsevier's ClinicalKey search service is designed to tailor content to physicians' day-to-day workflows

By James Sturdivant

Keeping Current

The idea of a Web-based product focused on clinical workflows is not new. Wolters Kluwer’s UpToDate clinical decision support system has been around for 20 years, but has obviously seen a lot of changes in that time. “It’s always been an online point-of-care resource designed to answer clinical questions,” says Denise Basow, president of UpToDate. “Over time it has replaced books and journals for physicians.”

UpToDate is designed to answer clinical questions, on the premise that fast, accurate answers change and improve decision-making. “We now have lots of data to show that answering those questions does change diagnostic and treatment decisions, and when they change those decisions … that improves patient outcomes.”

UpToDate is focused on speed of search. “If we don’t get physicians answers to their questions within 10-15 seconds, they are not going to use it,” Basow says. To facilitate quick search, UpTo Date is structured around what the company calls “topic reviews”—outlines addressing clinical questions related to a particular topic. Doctors searching within the system get a series of topic titles that lead to specific, relevant information. “At the point of care they usually want to read a paragraph or two, not pages of content. So the search is really focused on getting them honed in on what they want.”

Like Clinical Key, UpToDate also learns from each search. Queries are compared with past searches on the same subjects, and this information is used to point doctors to the most frequently utilized information. With over 17 million searches a month, this constitutes a powerful tool for improving practical functionality.

Making sure the system is available anywhere, any time, has been a priority. To allow the product to integrate thoroughly into workflows, UpToDate is designed to be compatible with a wide range of medical system software, allowing for the inclusion of search boxes and info buttons within hospital systems, and for contextual information held by those systems, such as a patient’s age and gender, to be automatically integrated into a search.

The product is closely integrated with other clinical decision and point-of-care tools in the Wolters Kluwer universe: Lexi-Comp, which provides drug information; Sentri7, a tool for aggregating and monitoring patient subscriptions and drug dosage; and ProVation MD, a tool for documenting clinical procedures.

The level of integration depends on the product. A search box included within the Lexi-Comp interface, for instance, allows for quick searches within UpToDate; with ProVation, physicians can see UpToDate content as they use the product.

UpToDate is a subscription-based service available as an all-in-one offering (subscriptions are not broken out by specialty). “We thought that was very important because we have a lot of data showing that at least half the time, physicians are asking questions outside of their own specialty,” Basow says.

—James Sturdivant

In an age of instant information access, professional and scholarly publishers have to get smarter when developing products to fit audience workflows. Simply having a large catalogue of titles is no longer enough; from finance to education to STM, users expect information to be tailored to their day-to-day needs and priorities. Meeting these requirements can spell the difference between a successful product and a dud.

In the medical field, semantic search technology has enabled targeted features that put information before users in new ways. Elsevier, the global publishing giant, has found a way to repurpose its vast stores of books and medical journals (constituting 25 percent of the world's research, according to the company) with a focus on the way doctors seek and use information in the course of providing clinical care.

"On the health science side, what we saw was we had this amazing data, but we found that practicing physicians, clinical physicians in the hospital weren't able to access it, to pull it out in a way that was as useful as it might have been," says Jim Donohue, Managing Director, GCR/Elsevier Health Sciences. "The days of a doctor thumbing through a large medical textbook are over."

The key, Donohue says, was to build in discoverability—though this is easier said than done. Exactly how do doctors search for information? What search results are most valuable to them, and when? The company talked to more than 2,000 doctors, had physicians keep diaries of how they used information and conducted over 20 focus groups in an attempt to understand exactly how content was used.

"We realized we had the content but probably not in the format that we needed," Donohue says. The result was ClinicalKey, an online search portal drawing from all of Elsevier's clinical content: every book, journal and content delivery mechanism related to patient care. Over 20 million pieces of content are semantically tagged down to the sentence level and linked to a proprietary taxonomy. "When a physician enters a search term into ClinicalKey, they get a clinically relevant response, versus a Google response or a Wikipedia response, where heaven knows what you get, there is no curating at all."

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